Psychiatry Investig.  2025 May;22(5):552-563. 10.30773/pi.2025.0033.

Network Structure of Depression and Anxiety Symptoms in Older Asian Patients With Depressive Disorders: Findings From REAP-AD3

• Park SC
• Kim K
• Park J
• Choi S
• Lee S
• Cho S
• Kim E
• Si TM
• Kallivayalil RA
• Tanra AJ
• Nadoushan AHJ
• Chee KY
• Javed A
• Sim K
• Pariwatcharakul P
• Kato TA
• Lin SK
• Shinfuku N
• Sartorius N

• KMID: 2567890
• DOI: http://doi.org/10.30773/pi.2025.0033

Abstract

Objective
The clinical presentation of depressive disorders might be influenced by age, and its diagnosis and treatment can be affected by ageism-related bias. A network analysis can reveal symptom patterns unrecognized by the reductionistic approach. Therefore, this study explores the network structure of depression and anxiety symptoms in older Asian patients with depressive disorders and examines age-related differences in the context of ageism.
Methods
We used data from the Research on Asian Psychotropic Prescription Patterns for Antidepressants, Phase 3 study and included 2,785 psychiatric patients from 11 Asian countries. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. Network analyses were conducted to identify symptom interconnections and centrality among older (>65 years), middle-aged (35–64 years), and young (18–34 years) adult groups. The network structures were also compared using a network comparison test.
Results
Depressed mood was the most central symptom across all age groups. Network comparisons revealed no significant structural differences among the three age groups, despite several variations in terms of global strength. The network structure of the older group was characterized by strong interconnections between somatic symptoms (insomnia-energy) and core depressive symptoms (little interest or pleasure-feelings of hopelessness).
Conclusion
This study reveals that the network structures of depression and anxiety symptoms have relatively consistent interconnections across age groups, despite subtle age-based differences. Specifically, older adults tend to present anxiety and depression symptoms as physical complaints. These findings challenge ageist stereotypes and advocate for inclusive, age-neutral approaches to treatment.

Keyword

Age; Ageism; Anxiety; Asian patients; Depression; Network analysis